Provider First Line Business Practice Location Address:
110 CARLTON ST.
Provider Second Line Business Practice Location Address:
ADERHOLD HALL, UNIVERSITY OF GEORGIA
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30602-7154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-542-4587
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006